Self-Bill Reporting to Carrier

In lieu of providing a carrier with a list of enrollments, which involves managing adds, terms, and changes, a carrier may allow a client to self-bill. Self-bill allows the client to report monthly the number enrolled, enrolled benefit, and total premium cost. Along with the self-bill, the client remits premium payment due. In the event of a claim, the carrier will contact the client to verify specific coverage amount and eligibility dates as part of the claims process.

Advantages:

Simplifies the administrative process from the carrier perspective since they are not maintaining enrollment details on the member level.

Eliminates needs for adjustment calculation

Eliminates time consuming monthly carrier bill audits

NOTE: The LTD "benefit" reflected on this report is actually reporting the Total Covered Monthly Payroll. If the true total benefit is needed for reporting to a carrier, the user may find this amount listed in the Carrier Billing Report found in the Benefit Reports section.

Creating Self-Bill Report

Use the Carrier Billing Summary to download a copy of the self-bill report. This is a summary of the number of covered members, total benefit amount, and the total premium due. It is recommended to run the report with consistent dates each month to generate the summary of all employees with active coverage as of the date run.

The Carrier Billing Employees With Rates and Groups can be run in conjunction with the summary to obtain the details to audit the summary. Employee recommends best practice of running both the Summary and Employees with Rates and Groups each billing cycle, auditing data validity, and retaining copies locally for reference.

The premium cost reported is the sum of all individual’s premiums within the reporting grouping. In some cases due to rounding, the total premium due may not be the same as calculating rate times total benefit. Depending on the size of the group, the variation may be pennies. We have created a separate report called “Self-Bill Summary Report” which calculates the premium due based on the total covered benefit which should be used if the carrier is reporting rounding issues with the total premium reported.

How are adjustments handled on self-bill?

It has been our experience that clients who are doing self bill reporting are not making premium adjustments due to terminations or new hires after the bill has been created. Typically, the reports are run based on active participants on a given date, such as the 1st or 15th of the every month. The premium is paid the month in advance of the coverage, so there are typically changes affecting both credits and debit. For example, new hires who weren’t added in to the system prior to the bill creation or terminations who were processed after the bill was created. The carriers and groups who are currently doing self-bill reporting, understand that some months there may be some credits missed, and other months where some additional premiums may be missed; however, over the course of the entire year, they balance each other out. Self-bill reporting simplifies the administrative process from the carrier perspective since they are not maintaining enrollment details on the member level and no longer require the premiums adjustments.